Use of a content methodology process to enhance feeding abilities threatened by ideational apraxia in people with Alzheimer's-type dementia.

Self-feeding behavior is often the first of a chain of self-maintenance skills to deteriorate in people with Alzheimer's-type dementia and is a major determinant of institutionalization. Moreover, nurses working in geriatric settings report the feeding of patients as a most difficult management problem. Of the various features of Alzheimer's-type dementia that can affect a person's ability to feed him- or herself, ideational apraxia can explain the loss of ability to conceptualize, plan, and execute the complex sequence of motor actions involving the use of tools or objects necessary for feeding. In this article, a systematic process is used to review the research literature to develop substantive content for nurses caring for people with feeding problems related to ideational apraxia. Ideational apraxia is a condition in which an individual is unable to plan movement related to an object because he or she has lost the perception of the object's purpose. The specific abilities necessary for feeding that are threatened by ideational apraxia are identified. A tool to assess these abilities is described, and nursing interventions aimed at enhancing or preserving existing abilities, preventing excess disability, or compensating for lost abilities are presented.